Acute Laryngotracheobronchitis (Croup)

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Croup is a common, respiratory tract illness which affects the larynx and trachea, and may also extend to the bronchi. Croup is the most common aetiology for hoarseness, cough, and onset of acute stridor in febrile children. The vast majority of children with croup recover without consequences or sequelae; however, it can be life-threatening in young infants.

Causes

  • Viruses
  • Parainfluenza virus (75% of cases)
  • Second most common pathogen: respiratory syncytial virus (RSV)
  • Adenovirus
  • Influenza virus

Signs and symptoms

  • Rhinitis (coryza) with nasal discharge and congestion
  • Low-grade fever
  • Barking cough
  • Hoarseness
  • Stridor due to subglottic narrowing
  • Dyspnoea 
  • Pallor
  • Tachycardia 

Differential diagnosis

  • Acute epiglottitis
  • Epiglottitis (supraglottic laryngitis)
  • Laryngeal diphtheria
  • Foreign body (FB)
  • Measles
  • Diphtheria

Complications

  • A secondary bacterial infection may result in pneumonia or bacterial tracheitis

Investigations

  • Diagnosis of acute cases is usually established clinically.

Treatment objectives

  • Prevent asphyxiation
  • Treat inflammatory oedema

Non-pharmacological treatment

  • Humidification
    • Cool mist from a humidifier
    • Or sitting with the child in a bathroom (not in the shower) filled with steam generated by running hot water
  • Encourage oral intake of warm, clear fluids to loosen mucus in the oropharynx  
  • Avoid smoking in the home; smoke can worsen a child's cough.
  • Keep the child's head elevated.

Pharmacological treatment

Dexamethasone IM

Administer 0.6 mg/kg as intramuscular injection

OR

Dexamethasone 0.15 mg/kg

AND

Adrenaline nebulized

400 micrograms/kg (maximum 5 mg)

Treat fever with an antipyretic such as acetaminophen or ibuprofen 

Prevention

  • Avoid contact with infected persons
  • Isolate infected persons